Template Improves Quality of Report on MRI for Multiple Sclerosis

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The MRI template report accounts for number of lesions, loss of brain volume, presence of enhancing lesions, T2-weighted/FLAIR white matter hyperintensities, and T1-weighted white matter hypointensiti
The MRI template report accounts for number of lesions, loss of brain volume, presence of enhancing lesions, T2-weighted/FLAIR white matter hyperintensities, and T1-weighted white matter hypointensiti

Use of a standardized template for reporting of brain magnetic resonance images (MRIs) in patients with multiple sclerosis (MS) improves accuracy and satisfaction among neurologists who read the reports, a small, internet questionnaire-based study published in the Journal of the American College of Radiology showed.1

Five neurologists from top US institutions outside the study area (who were blinded to patient identifiers) were asked to evaluate a sample of reports produced using a novel HIPPA-compliant template developed under a prospective quality improvement initiative for the examination of MRIs used in the diagnosis and management of MS.

The template was designed to incorporate evaluations and quantification of all elements specifically relevant to the detection and treatment of MS based on McDonald criteria, including the number of lesions, loss of brain volume, presence of enhancing lesions, T2-weighted/FLAIR white matter hyperintensities, and T1-weighted white matter hypointensities. The researchers found that reports using the template were far more disease-relevant compared with reports that did not use the template. They were far less likely to omit observations of findings specific to MS, and at the same time were more likely to include greater depth of detail of such observations. The researchers speculated that the template served to provide a checklist for the radiologist writing the report.

The 5 blinded reviewers were each assigned 10 sample contrast-enhanced MRI reports using the template and 10 using traditional reporting techniques for evaluation. These were selected from a total of 156 MRIs ordered during the period from February 1, 2015, to January 31, 2016, in patients presenting to a Veteran's Affairs (VA) tertiary hospital with known or suspected MS. Four out of the 5 neurologists strongly agreed, and the remaining neurologist agreed that they relied heavily on MRIs to monitor disease status in their patients with MS.

The reviewers commented that the template reports provided significantly more detail overall and a greater degree of detail specific to MS when compared with the nontemplate reports, and they generally rated the quality of the reporting to be higher using the template. Conversely, they also had fewer low ratings for the template reports and consistently rated them best overall.

Differences were also noted in the responses to questions about clinical management decisions between the two reporting types: reviewers elected to maintain current MS therapy based on 83% (40/48) of template reports compared with only 69% (34/49) of nontemplate reports, and they made recommendations to increase therapy based on 10% (5/48) of template and 16% (8/49) of nontemplate reports. The significance of this was not reported.

Although the study was small, it supports recommendations of the 2015 Magnetic Resonance Imaging in MS (MAGNIMS) guidelines for increasing structure in the reporting of MRIs in the MS setting.

References

  1. Dickerson E, Davenport MS, Syed F, et al. Effect of template reporting of brain MRIs for multiple sclerosis on report thoroughness and neurologist-rated quality: results of a prospective quality improvement project [published online December 5, 2016]. J Am Coll Radiol. doi:10.1016/j.jacr.2016.09.037
  2. Rovira À, Wattjes MP, Tintoré M, et al. Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis—clinical implementation in the diagnostic process. Nat Rev Neurol. 2015;11:1-12.
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